妊娠期肝内胆汁淤积症羊水性状与妊娠结局的分析_临床医学论文.docVIP

妊娠期肝内胆汁淤积症羊水性状与妊娠结局的分析_临床医学论文 妊娠期肝内胆汁淤积症羊水性状与妊娠结局的分析_临床医学论文 【摘要】 目的 探讨妊娠期肝内胆汁淤积症（ICP）羊水性状与妊娠结局的关系。方法 对我院2003年11月～2007年5月住院分娩的患者资料进行回顾性分析，统计羊水污染率、新生儿窒息率、围生儿死亡率及剖宫产率等。结果 452例ICP中轻度326例，重度126例。羊水污染124例（ICP羊水Ⅱ级44例，ICP羊水Ⅲ级80例），重度ICP的羊水污染率为72.22％。9例围生儿死亡中8例为ICP羊水Ⅲ级，124例ICP羊水Ⅱ级及Ⅲ级病例中出现22例新生儿窒息。未正式临产及胎膜早破而在34周后行剖宫产终止妊娠的302例ICP，术中发现羊水污染的有72例。结论 ICP的羊水性状与病情程度基本一致，羊水污染预示着不良的妊娠结局，适时终止妊娠可降低围生儿病率。 【关键词】 妊娠期肝内胆汁淤积症 ［Abstract］ Objective To study the relationship between the prognosis of mother and fetus and the character of amniotic fluid in intrahepatic cholestasis of pregnancy.Methods Retrospectively 452 pregnant women of ICP inhospitalized in our department from November 2003 to May 2007 were analyzed.We had calculated about amniotic fluid pollution，fetal distress，perinatal mortality，cesarean delivery rates.Results There were 124 pregnant women of amniotic fluid pollution，in which there were 91 found in severe ICP，and in which we had found 22 fetal distresses.In 9 perinatal deathes，there were 8 women of amniotic fluid Ⅲ degree.When we were practising cesarean delivery for no laboring and premature rupture of membrane before 34 pregnancy weeks，we found 72 amniotic fluid pollution of 302.Conclusion The character of amniotic fluid is consistent with severity of ICP.The women of amniotic fluid pollution in ICP has worse outcome.Careful fetal assessment and appropriate terminating pregnancy might improve perinatal outcome. ［Key words］ intrahepatic cholestasis of pregnancy；amniotic fluid；total bile acid；fetal distress；perinatal mortality；preterm labour；cesarean delivery 妊娠期肝内胆汁淤积症（ICP）是以妊娠中晚期发生皮肤瘙痒、黄疸为主要症状，伴胆汁酸、肝酶等生化异常的疾病，具有复发性、区域性及家族聚集趋向。该病母亲的预后良好，产后2～3周即自然缓解；但易导致早产、羊水污染、胎儿窘迫、死胎等，使围生儿发病率和死亡率增高［1］。ICP致围生儿不良结局的发生机制目前尚不清楚，终止妊娠的时间一般选择在38周以前。我市位处长江中下游，是此病的高发地区［2］。本文就2003年11月～2007年5月在我院住院分娩的452例ICP病例资料进行回顾性分析，主要探讨羊水性状与ICP患者不良妊娠结局的关系。 1 对象与方法 1.1 研究对象 我院2003年11月～2007年5月分娩总数7968例，其中确诊ICP患者502例，ICP的发生率为6.3％，选取无其他妊娠并发症如糖尿病、子痫前期、贫血等的单胎产妇452例为研究对象，既往体健，否认心、肝、肾疾病史。 1.2 ICP的诊断标准 参照199